Provider Demographics
NPI:1669200770
Name:A2C HOME HEALTH
Entity type:Organization
Organization Name:A2C HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BANNISTER
Authorized Official - Middle Name:L
Authorized Official - Last Name:MWAANGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-498-8004
Mailing Address - Street 1:19182 HOOVER ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-8646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19182 HOOVER ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-8646
Practice Address - Country:US
Practice Address - Phone:810-498-8004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health